Mental Health Nursing Care for the Elderly

Mental Health Nursing Care for the Elderly

Nursing   April 29, 2013

Every year the definition of elderly changes, but maybe its fair to talk about the age of 65 as being the start of elderly. While this definition is somewhat arbitrary, it is many times associated with the age at which one can begin to receive pension benefits. At the moment, there is no United Nations standard numerical criterion, but the UN agreed cutoff is 60+ years to refer to the older population.

Elderly mental health care is an important issue that affects almost one in every five American adults who are in fact known to be affected by some form of mental illness or the other. These mental illnesses include suffering from dementia and psychosis, delirium as well as depression and schizophrenia.

Elderly mental health care today suffers from many lacunae and among these lacunae is the fact the majority of elders suffering from mental ailments shirk from getting them treated. It is commonly found that such elders will suffer their condition in silence and are ready to put up with many discomforts rather than face the stigma of being known as being mentally disturbed.

In today's day and age a worrying aspect to dealing with elderly health care needs is the fact that the cause of death in the twentieth century is radically different than what was common in the previous century. In the nineteenth century deaths were caused by acute as well as infectious ailments, though in these modern times the main killers are chronic as well as degenerative ailments of old age.

In most cases, mental health problems in elders that require treatment are quite conveniently ignored. Improper treatment of mental illnesses in elders seems to the most prominent reason contributing to high suicidal rate in these people. Many of these people require specialized mental health services.

There are several reasons that contribute to improper mental health services to the elderly :

1. In most cases, elders are reluctant to undergo treatment for their mental health disorder. They continue to harbor their minds with discomfort and stigmas, thereby showing resistance to leaving their homes and going to a rehabilitation center or a clinic.

2. Our society has never shown respect or dignity for individuals suffering from mental health problems. Even a mental health professional is apprehensive about an elderly person with such condition. Beliefs and attitudes of these professionals do have a significant influence on the quality of medical care provided to the patients.

3. Medical negligence is another big hurdle. In many situations, symptoms of mental health diseases are just written off as indicators of ageing.

Pediatric Nursing Management for Dehydration

Pediatric Nursing Management for Dehydration

Pediatric Nursing   April 29, 2013

Definition of Dehydration :

1. Dehydration is a condition where a person who did not undergo fasting experiencing or at risk of dehydration vascular, interstitial or intra-vascular (Lynda Jual Carpenito, 2000 : 139).
2. Dehydration is a lack of body fluids due to the amount of fluid that comes out more than the amount of fluid intake (Sri Ayu Ambarwati, 2003).
3. Dehydration is a disturbance in fluid balance, along with the output exceeds intake, so the amount of water in the body is reduced (Drs. Syaifuddin, 1992: 3).

Based on the above notions, it can be concluded that dehydration is the lack of extra cellular fluid which resulted in the migration of fluids or lost from the body.


3 Types Classification of Dehydration :

a. Isotonic dehydration
Isotonic dehydration is an equal loss of water and sodium. Isotonic means that the number of particles contained on one side of a permeable membrane is the same as on the other side, thus there is no fluid shift in either direction. The amount of intracellular and extracellular water remains in balance. This can be caused by a complete fast, vomiting, and diarrhea.

b. Hypotonic dehydration
Hypotonic dehydration is the loss of water and sodium at the same time but lack of water than sodium, serum sodium lower than the normal range of extracellular fluid was hypotonic body status to reduce the secretion of antidiuretic hormone, so that the water in the renal tubular reabsorption decrease in urine output to increase from an increase in extracellular osmotic pressure.

c. Hypertonic dehydration
Hypertonic dehydration is the loss of water and sodium at the same time, but the lack of sodium than water, it is higher than the normal range of serum sodium, extracellular fluid status was hypertonic. When lack of water than sodium, the increase in extracellular osmotic pressure, increased secretion of antidiuretic hormone, renal tubular reabsorption of water increased, reduced urine output.


Etiology of Dehydration

Various types cause dehydration (According to Donna D. Ignatavicus, 1991: 253).

1. Dehydration

• bleeding
• vomitus
• diarrhea
• hypersalivation
• fistula
• Ileustomy (cuts colon)
• diaporesis (excessive sweating)
• burn
• fasting
• therapy hypotonic
• suction gastrointestinal (stomach wash)

2. Hypotonic dehydration

• DM disease
• excess fluid rehydration
• severe malnutrition and chronic

3. Hypertonic dehydration

• hyperventilation
• water diarrhea
• diabetes insipidus (ADH hormones decreased)
• excessive fluid rehydration
• dysphagia
• Impaired sense of thirst
• disorders of consciousness
• systemic infection: increased body temperature.

Clinical Manifestations of Dehydration

The following symptoms or signs of dehydration by level (Nelson, 2000):

1. Mild dehydration (loss of fluids 2-5%, of its original weight)

• thirsty, restless
• pulse: 90 -110 x / min, normal breath
• normal skin turgor
• urine output (1300 ml / day)
• good awareness
• heart rate increased

2. Moderate dehydration (fluid loss of 5%, of its original weight)

• increased thirst
• rapid and weak pulse
• dry skin turgor, dry mucous membranes
• reduced urine output
• increased body temperature

3. Severe dehydration (loss of fluids 8%, of its original weight)

• loss of consciousness
• weak, lethargic
• tachycardia
• sunken eyes
• no urine output
• hypotension
• pulse rapid and smooth
• cold extremities

Management of Dehydration

Management in patients with dehydration (Doenges & Sylvia Anderson):

1. Antiemetic drugs (To overcome vomiting)

2. Antidiarrheal drugs
Spending excessive feces may be given anti-diarrhea medications.

3. Provision of drinking water
Provision of drinking water containing sodium sufficient to address the imbalance that occurs.

4. Intravenous fluid administration
In the severe dehydration, intravenous fluid administration is needed. Isotonic saline solution (0.9%) were intravenous fluids chosen for cases with near-normal sodium levels, as it will increase the plasma volume. Soon after reaching normotensive patients, half of normal saline solution (0.45%) is given to provide water to the cells and helps the disposal of metabolic waste products.

5. IV fluid bolus administration
Initial IV bolus administration of fluid in a fluid load test, to determine whether to increase the flow of urine, which showed normal renal function.